ENT/Optho Flashcards
Ciliary flush - what is it and what does it represent?
= circum-corneal hyperemia with conjunctival redness concentrated in area adjacent to cornea
- Significant corneal pathology (e.g., keratitis, anterior uveitis, acute angle-closure glaucoma)
First-line for bacterial conjunctivitis in contact lens wearer
Ciprofloxacin
What complication of bacterial conjunctivitis do you worry about for a contact lens wearer?
Keratitis - inflammation of cornea
What do you think of with FB sensation of eye with signs of conjunctivitis?
Adenovirus keratoconjunctivitis
What are you looking for in HSV keratitis on slit lamp exam?
Dendritic pattern
When does rebleeding typically occur for traumatic hyphema?
Within one week
What complicated bug do you think of for a contact wearer with conjunctivitis? What would you treat with?
Pseudomonas - fluoroquinolones (erythromycin)
Genetic syndromes associated with nasolacrimal duct obstruction (x3)
CHARGE, T21, and Goldenhar
When should retinal hemorrhages secondary to birth trauma to resolve?
By two weeks of life
What virus to think of with bilateral swelling to periauricular area and progressing to jaw
Adeno
Complications of AOM
Meningitis, abscesses, sigmoid sinus thrombosis, focal encephalitis, otitic hydrocephalus, CN palsy
Gradenigo syndrome
CN 6 palsy
-Suppurative AOM, anterior displacement of ear
Abx choice for mild to moderate sinusitis
Amoxicillin high dose
What is happening and what do you do for a child with tympanostomy tube insertion with otorrhea and ear pain?
Tympanostomy tube otorrhea
- reassurance if <7 days
- cipro and dex drops
Tx for mastoiditis
IV vanco and myringotomy tubes
Complications of sinusitis intracranially
CVST, epidural abscess, subdural empyema, meningitis
Other CNS-related causes for Vocal cord paralysis
Chiari, hydrocephalus, myelomeningiocele, birth trauma
Ddx for leukocoria
- Cataract
- Retinoblastoma
- Retinal coloboma
- ROP
- Persistent hyperplastic primary vitreous
- Coat’s disease
- Toxocariasis
- Retinal detachment/dysplasia
Location of (a) thyroglossal duct cyst and (b) brachial cleft cyst?
(a) midline
(b) anterior to SCM
x2 most common bacteria for otitis externa
Staph aureus + pseudomonas
What do you worry about for an orbital wall fracture?
-Trapdoor fracture = of inferior rectus muscle
What is the job of CN-7 vs CN-3 for the upper eyelid?
- CN-7 = like a hook that pulls the eyelid closed
- CN-3 = like roman columns to keep eyelid open
What do you see on imaging for orbital cellulitis?
- Sinus opacification
- Subperiosteal abscess
- Periorbital fat stranding
What to do about a subperiosteal abscess in setting of orbital cellulitis?
Expected finding
-Nothing to do as long as uncomplicated course
What is blepharitis and what is it associated with?
=eyelid margin inflammation
-Associated with meibomian gland dysfunction
DDx for ptosis
- Congenital = dystrophic levator muscle
- Mechanical = hemangioma
- Trauma
- Myogenic = muscular dystrophy
- Neuromyogenic = myasthenia gravis
- Neurogenic = CN III palsy
- Idiopathic
Clues on exam for congenital/infantile dystrophy of levator palpebrae superioris muscle?
- No eyelid crease
- Infant using frontalis muscle to open eyelid
What is the difference between (a) CN III palsy and (b) Horner syndrome related ptosis?
(a) BIG ptosis
b) Small ptosis, small pupil (anisocoria), interruption of sympathetic innervation (lighter pigmentation
Difference between hordeolum vs chalazion?
Hord = acute inflam Chal = chronic inflam
Presentation of dacryocystocele
=distal blockage = appears as purple/blue dot
Presentations for (a) conjunctivitis (x3 types), (b) keratitis, and (c) iritis-acute/chronic?
(a) Bacterial (purulent), viral (watery-mucoid), allergic (watery + pruritic), inflammatory (minimal discharge)
(b) pain, white spot on cornea, vision loss
(c) acute (ciliary flush with severe pain), chronic (no redness or pain in JIA)
What to worry about if pupil appears tear drop?
Ruptured globe
What is microhyphema + what happens to the pupil?
- Accumulation of blood in the anterior chamber of the eye
- Common after blunt injuries
- Pupil is shocked = slightly oval
What does WBCs within the anterior chamber of the eyeball bilaterally worry you about?
JIA associated uveitis
In terms of normal visual development, what should a (a) 6-8 week old, (b) 2-3 month old, and (c) 3-4 month old be able to do?
(a) eye contact + react to facial expressions
(b) interest in bright objects
(c) eyes aligned, fix+follow
At what age can amblyopia not develop after?
9-10 years old
What is amblyopia?
Abnormal visual development leading to decreased visual acuity
What x3 big causes of amblyopia (+ example of each)?
- Need for correction = refractive error
- Media opacity = cataract
- Malignment = strabismus
How can you treat strabismus?
- Occlusion = patching
- Pharmacologic = eye drops in good eye
Best test to detect strabismus?
Cover/uncover test
How long does it take for 90% of AOM with effusion to be completely cleared?
3 months
Extra-cranial complications of AOM
- TM perforation
- Mastoiditis
- Labyrinthitis
- Labrinthine fistula
- CN VII palsy
- Bezold’s abscess
- Periauricular abscess
- Cholesteatoma
What should you always use for a draining ear?
Ciprodex drops
Intracranial complications of AOM
- Meningitis
- Brain abscess
- Sino-venous thrombosis
- Gradenigo’s syndrome
- Otic hydrocephalus
- CSF leak
When to refer for tympanostomy tubes?
- Recurrent AOM with effusion
- Complications of AOM (mastoiditis)
- Bilateral effusion lasting >3 months with CHL
- Unilateral or bilateral OME lasting >3 months with other problems (discomfort, behavioural problems)
- At risk children
- Chronic retraction of TM
- Lack of response to medical therapy
What is the most common congenital birth defect?
SNHL
What is the most common cause of non-genetic hearing loss?
Congenital CMV
Risk factors for hearing loss (x5)
ABCD’s:
- Affected family member
- Bilirubin
- Congenital intra-uterine infection
- Defects of the ENT
- Small BW (<1500g), low APGAR, NICU
Absolute + relative indications for adenotonsillectomy
Absolute:
- OSA with AHI >5/hr + large tonsils
- Cor pulmonale
- Suspected malignancy
- Hemorrhagic tonsillitis
- Severe dysphagia
Relative:
- Tonsillar hypertrophy
- Recurrent tonsillitis
- Complications of tonsillitis
- Tonsilloliths + halitosis
Management of sinonasal infections
- Abx
- Nasal CC’s
- Decongestants
- Surgical intervention
In setting of nasal trauma + possible fracture, what do you want to ensure if not present on exam?
Septal hematoma
Most frequent area of bleeding for epistaxis?
-Little’s area or Kiesselbach’s plexus
What threshold do you look at for pre-vertebral soft tissue for RPA?
> 7mm at C2
>14mm at C6/C7
Where is the location of the defect if there is (a) inspiratory, (b) biphasic, and (c) expiratory?
(a) supraglottis
(b) vocal cords, subglottis
(c) trachea, bronchi
What are the causes of biphasic stridor?
=location vocal cords/subglottis
- Bilateral vocal cord paresis
- Subglottic stenosis
- Glottic web
- Subglottic hemangioma
- Subglottic cyst
- Laryngeal cleft
- FB
- Papillomatosis
- Croup
What are the causes of expiratory stridor?
=think trachea/bronchi
- Tracheomalacia
- FB
- TEF
- Complete tracheal rings
When to think of a subglottic hemangioma?
- When croup presents too early
- If there is a beard distribution of hemangiomas
When does laryngomalacia (a) present, (b) worsen, (c) plateau, and (d) resolve?
(a) First days of life
(b) 6 months of life
(c) 6-12 months of life
(d) 18-24 months of life
What can do as pre-op mitigation strategies for button battery?
-Home = honey
-Hopsital = sucralafate
10mL q10 minutes
Dx of a non-tender, growing lesion overlying parotid gland?
Mycobacterial avium adenitis
Tx for Mycobacterial avium adenitis
Clarithromycin x7-10 days
- I+D if medical tx not effective
- Excision if not improved
What hearing screen should you consider if (a) no risk factors and (b) risk factors present?
(a) OAE - otoacoustic emissions
(b) ABR = auditory brainstem response
Midline congenital neck masses
- thyroglossal duct cyst
- dermoid cyst
- teratoma
- cervical cleft
- ranula
- vascular malformation
Lateral congenital neck masses
- Branchial cleft cyst
- Hemangioma
- Thymic cyst
- Vascular malformation
- Laryngocele
What neck mass moves with tongue protrusion?
Thyroglossal duct cyst
What neck mass presents with calcifications on XR?
Dermoid cyst
What neck mass is smooth along SCM border?
-Branchial cleft cyst
What neck mass enlarges with valsalva?
Laryngocele
What virus to think about when bilateral conjunctivitis with bilateral preauricular LAD?
Adeno
What ENT infection do you think of when there is trismus?
Peritonsillar abscess
What is Gradenigo Syndrome?
- Complication of suppurative OM
- CN VI palsy
- Facial pain
Post-tonsillectomy halitosis secondary to superficial infection - what is the management?
Optimize tylenol and analgesics
Most common cause of SNHL?
Genetics
x2 most important aspects of management for mastoiditis
IV Abx + myringotomy tubes
What is a bezold abscess?
Complication of mastoiditis - infection that extends into the neck musculature
x4 day-time symptoms of untreated OSA
- Growth failure
- Fatigue, headaches
- Attention/behavioural
- Cardiovascular (pHTN)
Intracranial complications of sinusitis
Epidural abscess Subdural abscess Brain abscess Meningitis CVST
5 yo girl with nasal congestion. What supports a diagnosis of acute bacterial sinusitis?
a. fever for at least 3 days
b. rhinorrhea persisting 12 days
c. frontal headache
d. nasal discharge that changes from clear to purulent
B
- Baby with inspiratory stridor, soft voice, vocals abduct in inspiration, what is the diagnosis?
a) Laryngomalacia
b) Tracheomalacia
c) Vocal cord palsy
A
x3 things to worry about in setting of bilateral vocal cord paralysis
- Hydrocephalus
- Chiari malformation
- Myelomeningocele
Is tonsillectomy required for peritonsillar abscess?
No - but may be considered
Indications for tonsillectomy for tonsillitis?
- =/>7 in 1 year
- =/>5 in 2 years
- =/> 3 in 3 years
What x2 sinuses are present at birth?
Ethmoid + maxillary
What is the last sinus to develop
Frontal
What is a concerning complication of cataract surgery?
Glaucoma
Optic neuritis - resolved 3 months ago - how to counsel and what comorbidity is possible?
- Likely no recurrence
- MS
Triad of infantile glaucoma plus x3 other common sx
- Blepharospasm
- Tearing
- Photophobia
- Corneal enlargement, edema, conjunctival injection
Other names for (a) anterior and (b) posterior uveitis - and what one is typically painful?
(a) iritis - pain+
(b) chorioretinitis
How to treat for (a) anterior and (b) posterior uveitis?
(a) topical steroids
(b) systemic steroids
When is rebleeding from a hyphema likely?
1 week
